Tag: depression

Cary’s classic column from FRIDAY, JAN 11, 2008

I don’t know if this is just typical midlife stuff, or if I’m in serious psychological trouble.

Dear Cary:

I am a suburban husband in my 40s with two wonderful kids, a good marriage, a secure job and financial situation, no medical problems, no substance problems, or anything like that. I work in a technical field, but harbor pretensions of being a creative person. My emotional state has always been somewhat up and down, but in the past six months or so, it has moved more decisively into the negative territory than it has since high school, if ever. I’m always tense, and frequently feel hunted, like I’m barely holding on by my fingernails, just holding my life together. I feel as though it’s all I can do to keep my head above water.

Sometimes I am almost overwhelmed with panic, and at other times I get these flashes of depression, and I wonder how I’m going to make it through the workday. I feel as though it’s all I can do to stay on top of the details of my life, yet all I am actually called upon to do is drag my sorry ass to work, drag it home again and do the dishes sometimes. In the past I have had artistic endeavors, and one in particular that I consider my true passion and have devoted a lot of work to, work I am proud of. I feel I have betrayed that passion by not having any energy for it these days. I feel that my life is entirely defensive — there is no grip-it-and-rip-it attitude left. Things that used to make me feel more alive now just seem like hassles and pressure trips (like travel). Diversions that I once considered transporting or transforming are now almost irritating distractions. I have tried meditation, and have a sense that I should do it more often, but, you know, I don’t. Oh, and my libido has pretty much disappeared.

Is this just a run-of-the-mill midlife crisis? Looking back at what I’ve written, it actually seems a little more messed up than that, like textbook depression. There is no rational reason for the feelings of dread I feel most of the time. Should I just smack myself and stop whining like a little girl? How can I introduce some perspective into my life in a way that my gut and heart will understand? I strongly resist the idea of pharmaceutical help, which I’m sure a professional would steer me toward. Then again, maybe I’m like the adulterer who tells his mistress and himself that he’s miserable with his marriage but never seems to get around to divorcing his wife — actually much happier with the current situation than he lets himself believe. (What do you want? Look around and ask yourself: What have you got?) I’m quite functional and am good company: Most people who know me would be very surprised to know I wrote this.

What’s your take?

Out of Gas

Dear Out of Gas,

Well, I really appreciate your writing to me, first of all. And, sort of in line with what I have written above, I’m trying to stay away from the position of, like, knowing it all and being clever, which is the death of a real advice column, and instead just relate to people from the heart. So I can say that I’ve felt how you feel, and I’ve come close to clinical depression myself, and also steered clear of antidepressants. I did consult a psychologist and found out some pretty surprising things, things I hadn’t noticed or thought about. And I was able to make some adjustments and I’m better off for it. I don’t have those periods of blinding despair and depression that I had started to have. And I’m, uh, nicer to myself now. So I got out of my 40s without ending up in the nuthouse. Hurray for me, I’m an American male success story.

I don’t know why this seems to happen in the 40s, except that by the time you’re 40 if you’ve actually been working you’ve been doing meaningless bullshit for so long that it really starts to get you down. I’m not saying your work is totally meaningless but, come on, there’s something else you’d rather be doing. I mean, you can do your technical work for a while, and make a good salary, and put plenty away as investments, you can sacrifice for your kids’ future and put your own needs aside, you’re strong, you’re a man, you can handle it. But after 20 years of that it’s not surprising that you’re starting to fray. You’re not getting enough sleep, you’re having to do what other people tell you to do at work, you’re behaving yourself, you’re doing what you’re supposed to do so people don’t say you’re a creep or so your wife isn’t embarrassed by you. And that’s fine for a while, but Jesus, if you think of how you were at age 18, and what you liked to do, what gave you pleasure, what your ideals were, and you think what your life would be like if you had followed those ideals, and then you think if there is anything in your life today that meets those ideals … no wonder men in their 40s crack up. You’re not alone.

Speaking of being nice to yourself … man, you sound like you put yourself down a lot. You might think it’s just regular humility, not making too much of yourself, or being realistic. But behind it, you’d be surprised, there could be these assumptions you don’t even know you have, like, oddly enough, that you really do deserve to be slapped like a little girl. That you’re not good enough. That you’re a fraud. I mean, look at how you talk about yourself. You say you “harbor pretensions” of being a creative person. What kind of talk is that? Would you talk about somebody else that way? Creativity belongs to all people, regardless of class, race, economic level, gender, whatever. It’s not some special prerogative of the rich and the gifted, or the politically popular. What is with all this judgment, like you can’t write or paint or do music unless you are a professional at it? How did we get to this point as a culture?
What about having a little humility and saying, You know what, I feel better when I paint duck decoys, so I’m painting duck decoys. And fuck you, get out of my garage. And don’t call them figurines. They’re duck decoys.

OK, so that does not sound so brilliant. But that’s what I’m saying, that some of this stuff is not about being brilliant. It’s about being real. It’s about being truthful. It’s about being able to live with yourself.

So in a nutshell, here is my three-part program for you. First, do get yourself checked out as to the whole clinical-depression angle. Get your blood done and all that. If they say yeah, you’re a case, you can decide for yourself whether to take meds or not. But see what the clinicians say. If you don’t want to take any drugs, don’t take them. Just tell them you’re not taking any drugs. Just say you want to get checked out.

Second, start a program of taking care of yourself, meeting your own needs. Start tomorrow: Eat a good breakfast. Relax before you drive to work. Relax after you drive to work. At work, have a good lunch — I mean a healthy, well-prepared lunch. Take a full hour or whatever. Leave work early and go to the gym. Have a good two-hour workout, a sauna, a good shower. Or, if you don’t belong to a gym, do some running in the woods, or whatever you do for exercise. Then go home and have a good meal and hang out with the family. Get to bed early. Get lots of sleep. Don’t yell at anybody. Take it slow.

Try it again the next day, same thing. Get lots of sleep, eat well, plenty of exercise, take it slow. Goof off a little. Exercise. Enjoy the air. Take a look at your calendar. Schedule a vacation with the wife. Book a place with a hot tub and a slow pace.

And the third thing, which you can do on your own and also in conjunction with a therapist if you decide to go that route, is just recognize that there are tangible forces in the world working against you, and that you need to be conscious of how you are reacting to these forces. People say, “Don’t blame others for your problems,” and all that. Well, fine. But don’t introject either, OK? Don’t blame yourself. We’re living in pretty scary times. Don’t pretend that it doesn’t affect you. It’s healthy to have an adversarial view of those portions of the world that are against you. Life is a fight.

And if you don’t like your life, say so. If you don’t like going to work every day at the same time and driving the same route, and coming home to the same suburb, say so. It may help you start making some long-term plans for change. It’s not against the law to have complaints about the way our society is organized. You put monkeys in the suburbs, they’d go nuts; they’d tear the houses down and start living outside in the park. We’re all cooped up in these little houses and it’s spooky. OK, so I am an unreconstructed hippie and devotee of Buckminster Fuller and Paolo Soleri. Our suburban living may work fine for some, but it would drive me nuts.

We ought to protest in the streets simply because there is not enough joy in our lives! Why don’t we do that? Wasn’t it wonderful when we were 16 and we’d go demonstrate in the streets not even knowing what exactly was wrong or how to fix it, just saying we’re here, we’re fucked-up 16-year-olds and we’re not going to take it anymore! We don’t have to have all the answers. There’s a lot in this world not to like. I mean, where do you want to begin? And let’s not get started on all the killing, the explosions, the destruction that’s going on. I’m just saying, how can we not be affected by that?

So, to sum up: First, get yourself checked out by an expert to see where you are on the official spectrum of depressive episodes. Second, take concrete steps to eat better, get more rest and get more exercise. And third, get mad! Recognize that there really are many external forces working against you, and it’s not surprising or shameful to be affected by all this, the way the world is, the way you have to live your life. It’s good to be affected by it. It shows you’re human. It shows you’re awake. It shows you’re alive.

I’m suicidal a year after my miscarriage. Nothing helps

Cary’s classic column from THURSDAY, MAY 31, 2012

Dear Cary,

What happens when therapy doesn’t work?

I’ve battled most of my life with depression, the causes of which are probably not of very much importance (absent alcoholic father, frequent moving, mentorless young adulthood, spotty employment, fear of commitment, and the crowning insult, a miscarriage and the end of a relationship). Perhaps these things, along with hopefully some joys and accomplishments, are just things that make up life. Unfortunately, I have been short on joys and long on disappointment, which has led me to become a very negative person.

After my miscarriage last year, I decided to give therapy yet another chance. Despite going into it with an open mind, I have come to the realization that no one can help me. Not a therapist, not my mom, not any friends, not my astrologer. Sure, people will listen for a while. They will give well-meaning advice and pep talks. They may even tell me that I am full of good things and that the world is a better place with me in it. I have even tried things like pharmaceuticals, acupuncture and the like. I’ve done all the things that are suggested to people like me. Volunteer! Exercise! Take up a hobby! Do some yoga! Meditate! None of it helps, and all I want to do is end the pain in the only way I know how. I know that this will cause those around me to suffer, but I cannot hang around and be miserable indefinitely just so three or four people don’t have to deal with my loss and be sad for what, two or three weeks, plus maybe around the holidays?

I would like to know your thoughts about someone like me. I’m sure that there are many others for whom therapy was not helpful and who continue to suffer every day.

Miserable in Paris

Dear Miserable in Paris,

You will get over this depression.

A significant number of women remain depressed almost three years after a miscarriage.

But they come out of it. You will, too.

One study showed that 13 percent of women who had a miscarriage remained depressed 33 months after. That’s almost three years.

The fact that you are still depressed does not mean therapy didn’t work. It means you’re not there yet.

Of course, let’s be intellectually honest and admit that life has a tragic dimension. People will die unhappy. Some of us will not be able to rise out of whatever it is we are stuck in. Some of us will die senselessly in automobile accidents, others will be tortured by madmen, others will commit unspeakable crimes and get away with it, others will put guns to our heads and the trigger will jam …

To be equally honest, life has a miraculous dimension, and some of us will wake up one day and realize it’s not so bad after all, and our hormones will balance out or our neurotransmitters will start transmitting after being jammed, or we will eat the right carrot or see the right television infomercial and buy a juicer or get a crystal that cures us, and we will walk barefoot on the sunny streets of Santa Barbara believing that a fortune teller in Venice read our palm and everything is settled now, nothing to worry about, everyone is fine.

While we’re at it, let’s admit that no one really knows. But I want to be one of the ones who says, I want you to make it. I believe you will come out of this depression. I have been depressed myself, and I have read about depression and followed treatment regimes and read many letters from depressed people and talked to depressed people, and my experience has been that most people come out of it if they don’t kill themselves. So don’t kill yourself. Give your body time to heal. If you need to crawl into bed and stay there for a few days, do it. But also do the things that will eventually bring you out of it.

Maybe no one thing you do will cure you of depression. But each thing you do will help a little bit: eating well, exercising, talking about your experience with other women who have experienced the same thing, doing yoga, meditating, sleeping well, walking in fresh air, reading books with hopeful messages, studying “Feeling Good” by David Burns and doing the exercises in it, continuing therapy or finding a new therapist who will be more engaged, taking time off, getting a massage, doing breathing exercises, taking vitamins, getting your hair cut, doing one nice thing for your body every day, staying out of situations that make you depressed, seeking out laughter, seeing funny movies, staying away from alcohol and caffeine, taking a sauna, swimming, sailing, riding a ferry, being in the mountains, taking a long drive to a resort, seeing a great chamber orchestra, hearing jazz, giving money to street musicians, riding the Metro, buying some clothes, talking on the phone to people who really love you, petting a dog, going to a museum, standing on the Seine watching the tourists go by in boats, walking by Cathedral Notre Dame, taking the Eurostar to London, eating a croissant, checking your adrenal glands, remembering to laugh every hour … all these things together may help.

Still, you may remain depressed for a while. And it’s not easy to do what you need to do to get over depression when you are depressed. That’s the maddening thing about it. It’s hard to think well. It’s hard to form an intention and carry it out. I know. Yet we do what we can. We eke out a little life while waiting for rescue, while waiting in our shipwreck in our floating misery being eaten by the tides and pecked at by birds, while waiting to reach some kind of land and eventual comfort and bliss.

What happens when therapy doesn’t work is you keep trying. You try different things. You try cognitive therapy. You try everything. You try nutritional supplements, and you don’t stop any one thing. You keep doing all the things that could possibly work. You keep an open mind. You try antidepressants. You read and learn everything you can. You use your intelligence to tell yourself the truth, which is that you are going to come out of this, and then you try to believe yourself when you’re talking to yourself.

You tell yourself what happened: You had a miscarriage and a relationship ended and your support system fell apart, and you acquired a serious depression which you are eventually going to emerge from.

Here are some other things you can do. They may work and they may not. You might as well give them a try, while you’re waiting. Write down all the accomplishments you have ever had. Include things that happened in school and things that happened when you were a child. How were you able to take care of yourself and others in your household? Write down all the things you are proud of. Visualize the things you would like to have in the future. Visualize happiness. Visualize pleasure and exhilaration. How were you able to save others from abuse? How were you able to recover from trauma? What were the high points of your relationship? Envision them. Envision your happy moments.

Write down even all the little accomplishments you have had. Make a list of all the times you have felt happy. Look at them. See what elements they had. See if you can re-create some of those moments. Post this list on the wall where you can see it several times a day.

It can’t hurt.

As long as you are alive, you have a chance. Life, if you don’t die, is long. One or two years is not so long a time. I first visited a psychotherapist about 20 years ago, and I have seen several since then—four total. Four different practitioners of different healing arts, well, more actually, if you count others; and then there’s all the help I have gotten from individuals, and chance encounters, and all the meditation and exercise and walking and talking and traveling and reading and working.

I’m not depressed today. I’m listening to Bach, looking out over the garden, where there are purple flowers.

I would try everything. I would try fish oil supplements and exercise and vitamin B. I know for me nutrition is extremely important; I cannot have alcohol and only rarely can I drink coffee, and I must eat plenty of fish and vegetables and take vitamins. I must. I don’t care what the science says. That’s what I have to do.

Attitude also makes a difference.

We have this friend who thinks she is the luckiest woman in the world. She was walking across the street right in front of her house and a truck ran a stop sign and crushed her. She was dragged under the truck because the driver didn’t see her. But people saw her being dragged and screamed, and the truck stopped and she survived.

She’s in a wheelchair now but considers herself lucky because she survived. She was lucky enough to get an elevator put into her house so she could travel between floors more easily and not have to be carried. The thing is, with her roommate, they have to always remember to keep the elevator at the correct floor. Well, so her roommate’s friend comes over and leaves the elevator at the wrong floor. And she backs her wheelchair into the elevator and falls to the bottom.

But she survives! She considers herself the luckiest woman in the world because she survived.

Cary’s classic column from FRIDAY, OCT 14, 2011

I may seem like I’m OK, but I’m hiding in my dorm room crying

Dear Cary,

I have been wanting to write to you for a while, but I always put it off because I think I can fix it myself or that the feeling will pass. As time wears on, I no longer believe that I can.

I am soon to graduate from a big, expensive university with a middling GPA. As I slog my way through this semester, I find myself feeling ever more hopeless and withdrawn. Upon arriving on campus freshman year, I promptly had a complete nervous breakdown. I was a thousand miles away from home, surrounded by all these golden children of Westchester and Greenwich, and I couldn’t handle it. I begged my parents to withdraw me from school, but they couldn’t comprehend why I would react in such a way. I stuck it out through freshman, sophomore and junior year at the same school. I was miserable each and every single day the entire time.

I have hardly made any friends during my time here (and I imagine that I must be the only person at this entire university with such an accomplishment). I never have any weekend plans and I stay in my dorm room most of the time. I don’t have such great grades, and particularly this semester, I find it increasingly hard to even make it to class or hand in assignments.

Why didn’t I transfer? It’s hard to say. I have this knack for appearing exceptionally functional. I can act peppy and upbeat all day long, but I will absolutely collapse in my bed sobbing every night. I imagine that the only event that can possibly remove me from this blanket of anxiety and fear would be total unconsciousness. A while back, I saw a therapist at my university for a few sessions. I couldn’t articulate any of my feelings to her. All that happened was that she commended me for being a “mature young woman.” That’s what I must seem like on the outside, I guess.

I’m submitting my résumé to various jobs now, and my application often gets denied with nary a first-round interview offer. I imagine how things will be post-graduation. I have no great hopes of being a high-powered executive or a successful writer. I have no dreams about white picket fences, 2.5 children and a loving husband. I desire absolutely nothing, except to live comfortably without anxiety.

While I don’t want to hurt myself, I find it just so difficult to make it through each day. I feel positively alone and exposed. I just don’t know what to do with myself except lie in my bed, browsing the Internet for hours upon hours until I fall asleep. While I know that if I just continue to eat, sleep and breath, this semester will be over and I will finally graduate, I worry that the future will only hold much of the same. I don’t remember ever feeling truly “happy” outside of fleeting moments of fun and laughter. How can I stop being so alone and miserable?

A Pretender

Dear Pretender,

I would say the best way to stop being so alone and miserable is to begin an unflinching and courageous study of yourself. Through this you will learn what is happening to make you feel and behave the way you do and how to change.

It’s as simple, and as difficult, as that. Its results can be instantaneous and also can take a lifetime. It is the true calling of humankind: to know ourselves.

It is unfortunate that universities do not concentrate on this essential task as much as they might; many universities are little more than vocational training grounds for the elite vocations of leisure and power. They are not the sanctuaries for personal growth and learning that they might be in a more enlightened society. It sounds as though you have gone to such a university and it has been pretty much nonstop torture.

It is time for the torture to end. It is time for you to begin your true course of learning.

I can make some guesses, but I am just a guy who set out to be a writer and ended up answering people’s letters for a living. I’m not trained in clinical psychology or philosophy.

Still, I can notice a few things. To me, it sounds like you have a lot of anxiety.

So, the short answer would be, to accelerate your study of yourself, that you begin learning as much as you can about this thing called anxiety: what it comes from, how it is treated, what steps you can take to lessen its impact on your life. Not all therapists are equally skilled. The one you consulted apparently did not identify your problem. No doubt you are skilled in masking your problems, but the job of a good therapist is to gently, skillfully, firmly, with compassion, help us take off the mask. Many therapists would more or less instantly grasp your situation and guide you through this difficult time.

You can help, of course, by learning about your condition.

This does not have to be a sad and frightening time. It is a time for discovery. You have nothing to fear. Once you begin to grasp your true nature, you will find an abundance of joy and pleasure in life. You are not far from the prize. You are just beginning.

I am not going to try to tell you very much. I am just trying to give you a gentle shove in the right direction. But I can tell you this, which may give you some hope: I have learned some techniques for dealing with anxiety. You can learn those techniques, too. I did get counseling and therapy, and you can get that as well.

One of the most important things I learned about anxiety was something a therapist said to me more-or-less offhandedly. He said, Well, you know, anxiety is often a method of warding off feelings. I thought, wow, that’s odd. I had never thought of anxiety as an active strategy, a creative act. But when I saw myself using anxiety to ward off feelings, I found I could direct my attention to the world, and what was going on, and to what feelings those might be that I was warding off, and I could see that my head would not explode if I just let those feelings come, and that things were basically OK minute to minute in spite of whatever feelings were washing over me.

Here is an interesting page to look at. I was searching for “therapeutic methods for dealing with anxiety” and I found this page. Its heading says, “Coping Skills for Trauma,” but it’s a really rich page full of suggestions for people who may be having anxiety and would like to get back into the present moment. What a wonderful set of suggestions!

In fact, I just did one of the exercises suggested on that website, and it was pretty calming. I looked around the room and saw an abstract expressionist painting by Judith Lindbloom, framed by my sister Melinda in her shop in Lynchburg, Va.; a table lamp bought at Target; a box of thumbtacks used to post fliers on billboards; a pair of reading glasses bought at Walgreen’s; a pass to the Litquake after-party. Those are five things just sitting here within easy view. Looking at them reminded me of my connection to the world, to my sister and my friend Judith, to our enterprise of doing workshops and posting fliers about them; to our shopping trips to Target; to my eyesight; to my participation in Litquake. It quickly grounded me. It brought me back into my life, the life that I’m living — the only life I’m living.

So these techniques can quickly bring us back into the life we are actually living. And when you think about it, it’s amazing how little attention we may be paying to the life we are actually living. And it’s often surprising how rich our lives are, when we stop to inventory what is in our lives. Your life, I feel sure, is very rich, too. Your problem is that you cannot experience it because you are warding it off. But this can change.

So, let’s just be honest. I’m a champion at warding off feelings. It may be because as a kid I was the kid who always was having too many of them — too many feelings about too many things; and feelings that were not simple, either, but required explanation and analysis, or simply needed to be said. That wasn’t working too well in my family, I found at an early age. Being the kid with feelings was not really the way to go. So I don’t know exactly what I did, because I wasn’t there. Or I can’t be there now. I can’t remember exactly what I did, what I decided to do. But I do know I learned to act quite analytical about my feelings, as though they belonged to someone else. And I learned not to say what I was feeling but to say something else — that the president is a numbskull or that certain chemicals are fascinating, that there will be a full moon tonight or Did you know…

You get what I’m saying? And I connect these two things: I connect learning at an early age that direct communication about my feelings was not welcome or appreciated, and also that by side-stepping that, and stating factoids, or stating opinions about politics, or the weather, I could avoid the scorn, derision or sheer incomprehension that would appear on the faces of the people around me.

Meanwhile I was bursting inside! Meanwhile I had all these secret longings and fears! Meanwhile I lived an inner life of strange abundance and richness. Meanwhile I was the kid wandering around wondering about God, about plants, about the sun, about evolution, about raindrops and fusion energy and girls. In a nutshell, I guess … I was full of feelings and that made it hard. So anxiety became a way of of freezing the moment and directing attention away from the flow of feeling.

So now it has become important to find ways to get back in the flow of feeling even when those around me are not receptive. So I have a rich inner life and I am often consumed with my own thoughts and feelings. Anxiety is just one way of responding to the flow of consciousness and feeling.

So that is just a little bit about anxiety. For you, what I can say is that if you begin a study of your own nature and history, and find what characteristics you have, and then find a therapist or psychologist who can become your partner in helping you understand your own nature and your own history, and you continue this study on your own, unflinchingly, courageously, then you are well on your way to becoming a happy and fulfilled person. It isn’t easy or magical, but it is the way to a meaningful and happy human life.

Cary’s classic column from Thursday, May 26, 2005

My younger brother, 40, is an anxious, depressed social recluse. He lives with his dog in a basement apartment alone. He never answers his phone. He only returns calls if it’s urgent. He is getting more obese by the day, smokes and hacks and coughs, may be drinking. He now smells, doesn’t cut his hair. He’s so anxious, he’ll do anything to avoid discussing real issues (his) and talks only about superficial things.

I’m in the unenviable position of being the one who can intervene — or not. Although we have an older brother who would support me, he’s not prepared to lead the way. I’ve had many talks with my younger brother, pleading with him to see a doctor to get help. I’ve had my own mental health and addiction problems over the years, and I’ve shared my experience with him, including how much better I’m doing as a result of an SSRI I’m taking. I’ve offered to go with him to the doctor, to get him the names of people who can help. I’ve even told him I’d have to have him forcibly removed from his place if I felt he was becoming suicidal. He laughed it off. He still seems rational to talk to, but his life is crazy.

He lost his job about a year ago. It was a media job, pretty high profile. He’d been working at the same place basically since finishing college. He’s talented and attractive, but not proactive in the least; he got as far as he did mostly because others pushed and made opportunities for him. In his first serious relationship (with someone from work, a “star”), he allowed himself to be treated with a lot of disrespect and completely deferred to her needs. In the end, she ended it and got married to someone who could provide what she needed. Soon after that, my brother rebounded with another woman, also from work but not a high-profile girl. Instead, she was a sweet but impulsive, gregarious, high-energy party type. Within six months, he’d proposed and they soon married.

From almost the day after their marriage, my brother seemed to abdicate and begin retreating. He didn’t seem to worry anymore about putting effort into being positive, energetic, doing things. He became a lazy, withdrawn and bitchy guy who saw his work as his main obligation. True, his work required a lot of social energy; it required interacting with a lot of people; but he didn’t seem to have anything left for his wife. After years of this and a general decline that saw him more and more withdrawn — never returning calls to family or friends, so that eventually he had no friends left — his wife left him. A week or two later, our father, whom he also neglected over the past years, died; months later, he was fired.

I don’t fear that he’s suicidal at this point. What makes me angry is that I know, in one way, where this will end up, and it means I’ll be cleaning up for him because he’s refusing to take my help now. He’ll run out of money and become destitute, and I’ll have to either take him in or otherwise “solve his life” for him. I get exasperated often as I wonder how someone who is being served up help on a platter can be so damned stubborn and insist they’re “not ready for it” — knowing it’s going to get worse. On the other hand, I guess he might make some change once he hits the real rock bottom — who knows? I’m torn about whether I should intervene now or whether he should be left to go through this?

Big Sis

Dear Big Sis,

What strikes me about your brother is that within a matter of months he lost his wife, his father and his job. That would be a setback for anyone. Some people would bounce back fairly soon. They would get another job and work through their loneliness and grief on their own time. Others might be seriously shaken, but would at least maintain their standard of living and basic hygiene. He went into a tailspin. I wonder why.

It could be that he is clinically depressed. If at all possible, have him examined. The stress of events may have triggered an episode. But I must be careful with such speculation; not only am I unqualified to diagnose, but as a writer, my bias is toward meaning, not pathology. So perhaps this is not illness at all. Perhaps it is a kind of journey.

What kind of journey could it be? You say that he is talented and attractive, but not proactive, and that his success at work was largely due to the favorable actions of others. You say that in his first relationship he deferred to the needs of his partner. That leaves the impression that he is affable and charming but somewhat passive. Perhaps in the past whenever he faced adversity he would give up until someone came along to rescue him. This time there is no one to help him to his feet — not his dad, not his wife, not his co-workers — only you, big sister, only you.

I always look for signs that the soul is seeking knowledge. The soul seeks knowledge through adversity. Sometimes that adversity is self-generated. People break the law and get locked up; we call it acting out; we call it antisocial, as if in a perfect world none of it would happen. We do not often pause to consider the value of our dark journeys, the priceless material we carry back with us when we return, shaken but sobered by what we have seen.

While we are sometimes too quick to assume that abnormality is illness, that deviation is pathology, as I say, I am no kind of doctor. (If I were, I would be a crazy doctor crawling in the muck, a scary bearded banger of bells, a gonger, a shouter, a vibrating and unreliable sage. I would be applauding the insane as they are led away in wagons. I would not be the kind of doctor you want to mend an arm or fix a tooth.) So, again, you should have a real doctor find out if he’s clinically depressed, if he needs to be treated. If he is physically in danger, if he becomes suicidal, then perhaps to save a life a doctor has to intervene.

But perhaps he is struggling to accept adversity on his own. Perhaps, stricken by grief, alone in the world for the first time, he is trying to find out what difference it makes if he smells bad or not, if he answers the phone or not, if he succeeds or just sits alone in the dark with his dog. Perhaps he is on a twisted journey toward self-reliance. Perhaps in this way he is trying to become a man! As much as I want him to be OK, I also want to honor his decision to descend into a kind of funky, ugly madness.

In the meantime, what is your role? If you determine that he’s not in imminent danger, you stand by. You stand by like a tug when a ship is in distress, like a spotter for a gymnast attempting a difficult flip. Do not assume that simply because he has chosen to retreat to the basement with his dog that he is irretrievable. After he has gone where he has to go, he may emerge one day, blinking in the sunlight, looking strangely radiant, saying, Look, look what I found, I may have paid too much for it but look how it shines!

I wrote to you once about seven years ago — I was a faithful column reader before and until now. Your advice was spot on, and now I find myself in a heartbreaking situation that I hope you will shed your light on.

My husband and I have been married for six years. We have a mostly happy marriage with ups and downs. I love him. We have been struggling with my infertility this entire time. Basically, my ovaries have not and will not work. Of course I did not know this before we got married, although I suppose I should have wondered. I had never used birth control; I figured that the rhythm method just worked! Now I realize that my body did not work. These years of infertility have been heartbreaking. We have gone through a myriad of treatments. During this time, my husband has become increasingly cold and even cruel; certainly not compassionate. He feels like we are throwing our money away at the infertility industry. Most heartbreaking is, is that he will not adopt and will not use donor eggs (and his sperm) to have a child. In my mind, we have plenty of money — and there are ways to build a family. He just refuses. He doesn’t want kids that aren’t “his own”; he sincerely thinks he could not love them as his biological children (despite what every parent of adopted and donor-conceived children say; your commenters will surely say this, and saying this does not help). He doesn’t want to be forced to do something he doesn’t feel right about. I understand that.

I tell him that I need compassion from him, and he says he “doesn’t express love in this way,” and I need to just acknowledge the infertility and get over it. The infertility is ruining our marriage. I could imagine handling this mountain to climb, if I felt like someone was climbing it with me. I could imagine a euphemistically called “childfree” life, if I had not found out that my husband is so callous and unsupportive. The way that my husband acts, it’s as if he has fallen out of love with me. He says he loves me, although he sometimes says he just wants to “get away from all of it (i.e., divorce).”

Complicating the mess is that I have recently changed careers, which involves significant additional training, because I figured if I were not to have children, at least I could have a career that I found more fulfilling. He said that the infertility and my being in school is really hurtful, and he finds it difficult to talk about. Trying to communicate about it is like pulling teeth.

My school is in a different state — and we had planned to move to this state together; we were happy for a change. At the last minute he decided not to move; so now we live apart — although the “plan” is for him to move in about eight months. All of this is incredibly difficult.

I understand that my options are to divorce and become a single mother by myself (donor sperm + donor egg or adoption) or stay with him and not have children. I don’t want to be a single mother; I don’t want a divorce. I don’t want a divorce because that is not why I got married. I believe people who love each other — in sickness and in health — should be able to work things out. Perhaps you and your comments will astutely observe that it takes two to make a marriage work, and for whatever reasons, my husband has checked out. Perhaps. But he has not sent me divorce papers. But knowing that I could build a family but not doing so because of my husband’s recalcitrance is so painful I feel it in my chest <a href=”http://www.health.harvard.edu/newsletters/Harvard_Womens_Health_Watch/2010/November/takotsubo-cardiomyopathy-broken-heart-syndrome”>(takotsubo syndrome)</a>.

He has finally started to go to a counselor; I think that much of his meanness is a result of depression and his own grief and confusion.

I also think he doesn’t want to be labeled “the bad one,” who divorces his wife because she is infertile. I understand that my infertility is also a loss for him, even if he is handling it in a different way. I am in counseling too. We tried couples counseling to discuss our disagreement about creating a family, but it centered around his depression instead of our marriage and was not helpful after three months. Now that we live in different states, couples counseling is not happening. We see each other every month or so. We talk every day. He says he loves me. But once we start to talk about “next steps,” he shuts down. He is a bit passive-aggressive (he would rather not make a decision and then all of a sudden we are too old to adopt).

I feel like I am just waiting for him to divorce me. I don’t want to file for divorce because I can see through his pain and depression (and cruelness) to the person I loved and married. I don’t want to divorce him, when it is he who questions his commitment. I don’t want to divorce myself. Yet not having a family with children to grow old with is extremely sad. Your commenters will say to fill my life with other things (i.e., to change “childless” to “childfree”). But I already have great friends, hobbies, travel and a fulfilling career! How could it be any better? I had a great husband, and I hope he starts being one again. Childless won’t become happily childfree with a cruel husband. If I divorce, do I go on a dating site and say, “I’m forty and infertile! Who wants to adopt children with me!”? I would not have time to wait for someone else to have a family with — I would have to do it alone. How can I divorce the family I have, to adopt another family? The choices I have are all bad.

Thanks for your advice,

Infertile and Sort-of Alone

Dear Infertile and Sort-of Alone,

The key to your situation is for your husband to recover from depression. Depression can distort one’s thoughts and cause one to act cruelly. You can’t make any good decisions together, as a couple, as long as he is in depression. So the best decision you can make, right now, is to put off any permanent changes until he can be treated and show some improvement.

Does he resist treatment? He may. Until his condition becomes unbearable for him he may resist treatment. And it is a complicated situation. But the one clear message I want to send to you is that your husband is suffering from depression and that is the main problem in your marriage. So whatever can be done now to help him recover from depression should be your top priority as a couple.

His depression may resist treatment. It may last a long time. It may have several causes. He may have ups and downs. But it is the central issue and it can be treated.

Having children or not having children is not the central issue. The marriage is. A marriage can be a boundless source of energy and support for both partners if both partners are healthy; such a marriage can weather loss and disappointment. It can be a safe haven in which crucial decisions can be made. The question of children or no children may be a painful thing for him to face in his depression but it is not the central issue and it is not causing his depression. Nor is your moving to go to school causing his depression.

We don’t know what is causing it. But, again, it is my strong feeling that his depression is the factor that is pushing your marriage to the brink.

If nothing can be immediately done about his depression, or if he takes steps and there is no immediate improvement, then wait. Let life go on and let your marriage be in a holding pattern for a while. Meanwhile pay attention to your own needs; live on your own and wait. There is no need to divorce him yet. Just wait. Wait until he finds treatment and shows steady improvement or until one day you realize nothing is going to change and that his love is gone and the marriage is over. You may reach the point where you see that he is a lost cause and will never get better and there is nothing you can do. No one can say how long that might be but I feel certain that you will know if it reaches this point and that it will come to you as a kind of death. If it happens, it will come to you with fhe force of certainty and you will feel grief because it will be over. You won’t need anyone to tell you it’s over and you won’t need to guess or wonder. It will come to you that the marriage is over and then dissolving the marriage legally will be a formality. Then grieving will happen because the marriage is over, not because you are getting a divorce. It will be a kind of grieving because a kind of death has occurred, metaphorically speaking; he has gone so far into his depression that he cannot come out.

My guess is that this will not happen, that you will wait and he will improve and you will learn how to live together with your different feelings about children. You will have some shared loss and you will go on. That is what I see. The fact that he has started seeing a mental health professional is a good sign. There are many effective treatments. If he can find one, and stick with it, and improve, then the chances are good that you can have a marriage that works for you, even if it does not give you everything.

I pray that you will find the strength and wisdom to see this through.

In my early twenties, I went to graduate school to study English literature. I was deeply passionate about the written word and knew from the moment that I could read that I wanted to devote my life to this pursuit. Idealistic, I felt like providence had led me to that moment in my life, and I was ready to enter the academic and literary world where I would finally “belong.” Instead, I was met with a small circle of individuals who had greater desires for tenure than the actual sharing of knowledge and appreciation of language. The program was more clinical than I needed it to be. I was miserable in that environment and left graduate school early feeling confused and betrayed by the system that I had worked so hard to enter.

After leaving, I sank into a deep depression, only partly cured by a new relationship. I met a poet and fell for him quickly, all my passion for language being channeled toward him instead. I loved his poetry and the emotions that he conveyed with words. I felt fulfilled through my relationship with him (although it was a tumultuous one) and was inspired to write as we shared the same creative spirit. It was a long-distance relationship though, and he cheated with a woman he then married only a few months later.

In mourning that relationship, I met another writer who picked me up off the floor more times than I care to admit. I hate to sum him up as just a “writer” too, because he was everything to me. He had the same acute sensitivity to the world that I do. Every pain I ever felt echoed the same inside of him. We took turns spinning into depression and then giving/accepting consolation. We fell in love with each other’s words over and over again. Even his emails were art to me. He was the most precious part of my life and I trusted him implicitly (although his love of story telling often led to superior forms of embellishment).

He shot himself in the head almost four years ago.

I miss him.

All of this is to say that I do not know what to do with myself. I feel like I have writer’s block of the mouth and pen. I shy away from everyone and anything that I used to gravitate to because I feel so wounded by it all (whatever “it” is). I don’t know how to connect with people anymore. I don’t know how to write anymore. I feel so profoundly but have no outlet. I am disappointed in life, do not know how to go on without my partner even after several years, and do not know how to find others like me or make myself understood by those that are different. I am not under the impression that life should be happy all the time. However, I would like the ability to experience just a little bit of it every once in a while. Sometimes.

What should I do to get out of this current un-life? How do I find others with the same sensitivity to the world that can relate to me and I them? What do I need to do to feel inspired to write again?

Thank you for being there,

Despairing Former Writer

Dear Despairing Former Writer,

How do we recover from loss? We do it slowly. I am not surprised that you are still recovering from this traumatic loss, or series of losses — the loss of your graduate school dream, the loss of your intimate partner, the loss of your own creative practice.

As a first step, I suggest that you see someone trained in the treatment of depression and ask, candidly, if you appear to be depressed. If the answer is yes, then spend some time working with a therapist who is trained in the treatment of depression, sorting things out, getting help and support. I know what depression is like, and I know it can be treated and life can get better, and I also know the numbness and hopelessness and sense of worthlessness that come with depression.

At least find out. If you aren’t depressed, it will be good to have an expert opinion to that effect. You may just be grieving.

Either way, write through this pain. If you have not tried doing morning pages, as suggested in the book The Artist’s Way, try that. It is a good way to habituate oneself to daily writing after a period of inactivity. You do not need to feel inspired to write in order to write. You need only to write. Strangely enough, the writing will cause the inspiration, not the other way around.

May I share something with you? I, too, sought the companionship of fellow lovers of literature in graduate school and I, too, despaired and left, after learning mainly how to drink in bars.

I, too, have lived through bouts of depression. I have gotten help both professional and nonprofessional. What I cling to, and what I keeps me on this side of the suicide line, here with the living and not over the cliff with the suicides, is knowing that things will get better and that the steps I take will slowly help. In the bad times, in the down times, I do things to get through the day.

Writing will sometimes get you through the day. This morning I have been writing about my father, who had literary dreams but did not finish things, and how sad that was for me as a boy to watch, and how I have at times repeated my father’s pattern. And I have been thinking how painful it is to want to do better than one’s father, and the conflict that can bring, and how after leaving the family and all its particular horrors one wishes to find one’s genial tribe, and how there are many false tribes that will disappoint you, and how one’s true tribe are not found where you think they would be found — not necessarily in the graduate English department but out on the lawn smoking pot or working in mailrooms or as cab drivers, or devoutly following a calling.

In seeking our tribe we are often drawn to the ones who burn the brightest and promise the most. But do the ones who burn the brightest really have what we need, or are we just drawn to them because they burn so brightly? It seems to me it is often those who burn the brightest who let you down the hardest. Having fallen for this writer, having lost him so traumatically, you must be wary now of any trust, and not know how to distinguish between the dazzlers and the true friends. You may be wary that the ones who will dazzle you will also break your heart but not know who else to turn to. This is sure: Your heart cannot stand to be broken again. You need someone to be good and strong and kind to you. You do not need another romance with death.

Let me ask you this: Is there anyone among your close friends that you can totally rely on? Is there anyone you can lean on? Someone who loves you unconditionally? Family, a friend, a fellow lover of literature, a woman friend, someone? You need someone, not a lover, but a friend, not necessarily a brilliant person but a loyal person. Maybe a therapist would play that role; that is often the unexpected beauty of therapy, that we are able to fall in a kind of love with someone in an unproblematic way, for our own good, to reawaken our own capacity for love. This person need not understand your aesthetic complexities. You just need someone you can lean on.

I will tell you a little about my own recent experience of depression. First, some bad things happened, so it wasn’t like depression came out of nowhere; bad things happened both medically and socially. So when I sought treatment for depression, the professionals’ first thought was that I was socially isolated and needed IPT — InterPersonal Therapy. It then became apparent that I had some deeper issues that needed a psychodynamic approach. But out of that psychodynamic approach finally came the strength for me to essentially do IPT — to repair my social network. So now I am answering the telephone and responding to emails. I am cherishing the friends I have. I am reaching out. That is helping. Also I am working methodically on my literary craft. That, too, is helping. And I participate in 12-step meetings. That, too, is helping.

Maybe you still need to grieve this loss completely. I’m not sure, frankly, how one does that. I suppose that for each person it is personal. But there is some good to be had by saying it out loud: I need to grieve. I am grieving. Out of that comes acceptance of the melancholy, the heaviness and slowness. One can say, I am feeling heavy and slow with grief still. That does not mean there is something wrong with me, just that something terrible happened.

Something terrible happened. You are not over it yet. Eventually you will be.

Ask a professional about depression. Strengthen your social network. Identify people who are there for you. Lean on them. And write your way through it, too, not trying to be brilliant, but trying to tell the truth.